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16 May 2005
Surprise Findings In Hot Flash Treatment Tests 
Mayo Clinic researchers have been working with North Central Cancer Treatment Group (NCCTG) investigators to assess treatments to reduce hot flashes in women. In the first of two assessments, the Mayo researchers say that black cohosh does not reduce hot flashes in women any better than a placebo. Used extensively in Europe for treating hot flashes, black cohosh (Cimicifuga racemosa) is a herbal remedy derived from a plant of the buttercup family. The researchers say that the black cohosh study findings should encourage patients to look for other methods that can help control the common symptoms of menopause. "The findings demonstrated absolutely no improvement of symptoms when women took black cohosh compared to placebo," says Barbara Pockaj, of Mayo Clinic in Scottsdale. "This finding is extremely important, because we can now say to our patients that black cohosh does not work and we have to try other methods to control their symptoms." Participants in the study kept a daily hot flash diary during the treatment period where they kept track of the daily number of hot flashes and their severity. Mayo researchers measured patient treatment preferences by ascertaining which treatment, if any, the patients preferred: 34 percent of patients preferred the black cohosh treatment, 38 percent preferred placebo and 28 percent did not prefer either treatment. In the second assessment, Mayo Clinic researchers outlined current data comparing the effectiveness of two medicines - the antidepressant venlafaxine (Effexor) and a progestational agent - in combating hot flashes. Previous studies have shown that both venlafaxine and progestational agents substantially decrease hot flashes. This trial demonstrated that a single dose of the progestational agent, medroxyprogesterone acetate (MPA), alleviated hot flashes more than did the daily use of the oral antidepressant venlafaxine. This difference became even more striking after six weeks of treatment, says Mayo oncologist Charles Loprinzi. "This improved hot flash benefit appeared to last for at least six months following a single MPA dose, with almost three times as many patients still reporting a 90 percent hot flash reduction following MPA versus patients receiving daily oral venlafaxine," said Loprinzi. The researchers also noted that 24 percent of patients who received MPA reported no hot flashes after six weeks compared to 1 percent of venlafaxine patients. Patients on MPA also reported less trouble sleeping, less sleepiness, less constipation, less abnormal sweating and less hot flash distress than patients on venlafaxine.
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